One of the more challenging consultations in nephrology is evaluating a pregnant patient beyond 20 weeks’ gestation who presents with worsening proteinuria, high blood pressure, and increasing serum creatinine. In these situations, I am faced with deciding whether the findings show preeclampsia or the unmasking or progression of underlying chronic kidney disease (CKD). Preeclampsia often follows a more aggressive course and, in severe cases, may necessitate early delivery. In